Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium.

BACKGROUND: The relevance of blood lipid concentrations to long-term incidence of cardiovascular disease and the relevance of lipid-lowering therapy for cardiovascular disease outcomes is unclear. We investigated the cardiovascular disease risk associated with the full spectrum of bloodstream non-HDL cholesterol concentrations. We also created an easy-to-use tool to estimate the long-term probabilities for a cardiovascular disease event associated with non-HDL cholesterol and modelled its risk reduction by lipid-lowering treatment. METHODS: In this risk-evaluation and risk-modelling study, we used Multinational Cardiovascular Risk Consortium data from 19 countries across Europe, Australia, and North America. Individuals without prevalent cardiovascular disease at baseline and with robust available data on cardiovascular disease outcomes were included. The primary composite endpoint of atherosclerotic cardiovascular disease was defined as the occurrence of the coronary heart disease event or ischaemic stroke. Sex-specific multivariable analyses were computed using non-HDL cholesterol categories according to the European guideline thresholds, adjusted for age, sex, cohort, and classical modifiable cardiovascular risk factors. In a derivation and validation design, we created a tool to estimate the probabilities of a cardiovascular disease event by the age of 75 years, dependent on age, sex, and risk factors, and the associated modelled risk reduction, assuming a 50% reduction of non-HDL cholesterol. FINDINGS: Of the 524 444 individuals in the 44 cohorts in the Consortium database, we identified 398 846 individuals belonging to 38 cohorts (184 055 [48·7%] women; median age 51·0 years [IQR 40·7-59·7]). 199 415 individuals were included in the derivation cohort (91 786 [48·4%] women) and 199 431 (92 269 [49·1%] women) in the validation cohort. During a maximum follow-up of 43·6 years (median 13·5 years, IQR 7·0-20·1), 54 542 cardiovascular endpoints occurred. Incidence curve analyses showed progressively higher 30-year cardiovascular disease event-rates for increasing non-HDL cholesterol categories (from 7·7% for non-HDL cholesterol <2·6 mmol/L to 33·7% for ≥5·7 mmol/L in women and from 12·8% to 43·6% in men; p<0·0001). Multivariable adjusted Cox models with non-HDL cholesterol lower than 2·6 mmol/L as reference showed an increase in the association between non-HDL cholesterol concentration and cardiovascular disease for both sexes (from hazard ratio 1·1, 95% CI 1·0-1·3 for non-HDL cholesterol 2·6 to <3·7 mmol/L to 1·9, 1·6-2·2 for ≥5·7 mmol/L in women and from 1·1, 1·0-1·3 to 2·3, 2·0-2·5 in men). The derived tool allowed the estimation of cardiovascular disease event probabilities specific for non-HDL cholesterol with high comparability between the derivation and validation cohorts as reflected by smooth calibration curves analyses and a root mean square error lower than 1% for the estimated probabilities of cardiovascular disease. A 50% reduction of non-HDL cholesterol concentrations was associated with reduced risk of a cardiovascular disease event by the age of 75 years, and this risk reduction was greater the earlier cholesterol concentrations were reduced. INTERPRETATION: Non-HDL cholesterol concentrations in blood are strongly associated with long-term risk of atherosclerotic cardiovascular disease. We provide a simple tool for individual long-term risk assessment and the potential benefit of early lipid-lowering intervention. These data could be useful for physician-patient communication about primary prevention strategies. FUNDING: EU Framework Programme, UK Medical Research Council, and German Centre for Cardiovascular Research

Health related quality of life in patients with idiopathic pulmonary fibrosis in clinical practice: insights-IPF registry

Background: The INSIGHTS-IPF registry provides one of the largest data sets of clinical data and self-reported patient related outcomes including health related quality of life (QoL) on patients with idiopathic pulmonary fibrosis (IPF). We aimed to describe associations of various QoL instruments between each other and with patient characteristics at baseline. Methods: Six hundred twenty-three IPF patients with available QoL data (St George's Respiratory Questionnaire SGRQ, UCSD Shortness-of-Breath Questionnaire SoB, EuroQol visual analogue scale and index EQ-5D, Well-being Index WHO-5) were analysed. Mean age was 69.6 +/- 8.7 years, 77% were males, mean disease duration 2.0 +/- 3.3 years, FVC pred was 67.5 +/- 17.8%, DLCO pred 35.6 +/- 17%. Results: Mean points were SGRQ total 48.3, UCSD SoB 47.8, EQ-5D VAS 66.8, and WHO-5 13.9. These instruments had a high or very high correlation (exception WHO-5 to EQ-5D VAS with moderate correlation). On bivariate analysis, QoL by SGRQ total was statistically significantly associated with clinical symptoms (NYHA;p < 0.001), number of comorbidities (p < 0.05), hospitalisation rate (p < 0.01) and disease severity (as measured by GAP score, CPI, FVC and 6-min walk test;p < 0.05 each). Multivariate analyses showed a significant association between QoL (by SGRQ total) and IPF duration, FVC, age, NYHA class and indication for long-term oxygen treatment. Conclusions: Overall, IPF patients under real-life conditions have lower QoL compared to those in clinical studies. There is a meaningful relationship between QoL and various patient characteristics

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

The Role of the Academic Library in Urban Development

published or submitted for publicatio

The University of Wisconsin Milwaukee: An Urban University

https://dc.uwm.edu/uwmhistory/1002/thumbnail.jp

Letter, from J. Martin Klotsche to Armando Orellana = Carta, de J. Martin Klotsche a Armando Orellana

A letter sent to Armando Orellana after the sit-in at the Chancellor's office.Una carta mandada a Armando Orellana después de la manifestación en la oficina del rector.The University of Wisconsin'- Milwaukee MILWAUKEe:, WISCONSIN &3liil01 OFFICE OF THE CHANCEL.L.OA CHAPMAN HAL.L. Mr. Armando Orellana September 1, 1970 Chairman, Committee for Education of Latin Americans 800 South Fifth Street Milwaukee, Wisconsin 53204 Dear Mr. Orellana: The University of Wisconsin- Milwaukee recognizes its obligation to meet the special educational needs of Spanish speak­ing citizens, as ~t recognizes its obligation to meet the needs of all citizens of the Milwaukee community •. We have had a number of special programs over the years which included Spanish speaking students, although we realize that the needs are much greater than UWM - or any one institution - can meet. Of course, we wish to do more and are prepared to admit up to 50 undergraduate students fr·om the Latin community during the course of this fiscal year under programs offering special educational and financial assistance. ../ We are extremely limited this year in the amount of money available to assist our students. But we will seek additional funds - from both the federal government and private sources - to provide financial aid to Spanish speaking students. This aid will be awarded .· in accordance with individual needs and the availability of funds. I , Before the fall semester begins, a UWM team of four specialists will go· :into the Latin community to give advice on academic and financial matters. Graduate students will continue to be admitted on an individu~l basis. Also, some 25 to 30 Latins will be included in the high sci.lool equivalency program which enables young people to earn a high school diploma. Mr. Armando 'Orellana, September 1, 1970, page 2. These students would be in addition to those who might normally be expected to enter UWM. Last fall, for example, about 100 students from the Spanish speaking community were enrolled. To help coordinate these programs and to work within the community to seek out candidates, I will appoint a special assistant in my office with the appropriate specialized background and skills. The requests for special courses and academic programs designed particularly for Spanish speaking Americans are matters for the faculti~s of the individual schools and colleges within the University. I have little authority over curriculum matters, but will recommend that the individual units undertake the development of appropriate special programs, including work in English as a second language. The deans of these schools' and their faculties also have the responsibility for related matters, such as the question of earning academic credit for field work in the community. There is precedent · for this in a variety bf profession~! fields, including education and social service. Let me again emphasize the desire of the University to cooperate with Spanish speaking citizens in creating ways to provide the educational programs .which they seek and which we wish to provide . . ! . . Cordially, . C)~~ JMK:cp J. Martin Klotsche Chancellor cc: President fred Harrington Vice President Robert Taylor Vice Presidynt 1Ch~rles A. Engman Regent Bernard C. Ziegler Regent Frank J. Pelise

The University of Wisconsin-Milwaukee: A Historical Profile, 1885-1992

https://dc.uwm.edu/uwmhistory/1001/thumbnail.jp

Unanswered Questions about Public Service in the Public Research University

Public service in the public research university is more important than ever before, but there is a need to discuss even the most basic questions about the subject. For example, what is meant by service? Who should be served? What methods should be used to evaluate service? What strategies and structures would strengthen service? What is the social responsibility of the university? This article addresses several such questions and some of the issues they raise. It draws on work in diverse fields and recognizes emerging efforts to develop knowledge in ways that serve society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68673/2/10.1177_088541229100500301.pd

Reinventing the Research University for Public Service

If the research university were reinventedfor public service, what would it be? This article addresses several such ques-tions and some of the intellectual and institutional issues they raise at a time when communities and universities are being challenged to develop capacityfor thefuture. It draws upon research and practice for analysis of the elements in the reinventing process, such as reconceptualizing research, integrating service into the curriculum, modifying the reward structure, changing the academic culture, and providing the leadership. It identifies obstacles to the process and ways to overcome them in higher education.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68353/2/10.1177_088541229701100301.pd